Acute kidney injury (AKI) is a widespread condition with severe detrimental effects on patient outcome. To date, general pharmacological therapies are not well-established; therefore, a specific therapeutic approach tailored to the underlying cause of AKI seems to be crucial.
Aim and methods
We provide an overview of recent publications questioning the importance of percutaneous renal biopsies in patients suffering from AKI. Additionally, we show examples of the clinical and histopathological experience from a tertiary hospital.
Several reasons favor the histopathological evaluation of the underlying conditions in patients with AKI: Firstly, a rapid clarification of the cause of AKI and loss of function by other methods, e. g. after kidney transplantation, is often not possible without a histopathological assessment. Secondly, characterization of the disease, especially activity and severity, is important prior to the initiation of a potentially damaging therapy. Thirdly, clinical or serological data might not be available at the time of biopsy. Unexpected findings are therefore not unusual. Further knowledge of chronic changes (e.g. glomerular sclerosis, tubular atrophy, interstitial fibrosis and arterial lesions) is essential for planning therapeutic strategies. These and other morphological parameters of a kidney biopsy in AKI seem important in terms of an evidence-based personalized approach to the treatment of patients; however, a strict risk-benefit analysis must be performed for each individual patient, as critically ill patients are especially susceptible to severe bleeding complications.